Clinico-epidemiological profile of hepatitis A virus and hepatitis E virus co-infection in pediatric age group: a hospital based retrospective study

Background: Hepatitis-A virus (HAV) and Hepatitis E virus (HEV) are two major hepatotropic viruses of great public health importance in the developing countries like India. Both HAV and HEV are enterically transmitted and there are speculations that their co-infection might be associated with a more severe clinical course and increased rate of mortality. The objective of this study is to determine the prevalence, clinical features and biochemical parameters of Hepatitis A and Hepatitis E co-infection in hospitalized patients at a tertiary care centre in Uttarakhand.Methods: It is a retrospective study, covering a period of 4years and conducted in Himalayan Institute of Medical Sciences, SRHU Jolly Grant, Dehradun. Records of the patients with Hepatitis A and Hepatitis E co-infection were retrieved and analyzed.Results: Out of total 125 patients of acute viral hepatitis, 13 patients had HAV and HEV co-infection. 100% of the patients with co-infection presented with complaints of fever and jaundice, followed by 76.92% with vomiting, 69.23% with pruritis, 61.53% with pain in abdomen and 23.07% with altered sensorium. Mean Bilirubin, ALT, AST were 8.69'7.27 mg/dl, 2030.69'1726.93IU/L and 1880.07'1881.11IU/L respectively. Average duration of stay was 8.2 days. Encephalopathy was seen in 2 patients. However, no mortality was reported.Conclusions: Co-infection of HAV and HEV is not rare in pediatric age group. Knowledge about this will be of immense help for planning of future vaccination strategies and for better sanitation program in developing countries like India.

Megaloblastic anaemia in hospitalised children.

Objective: To study the profile of megaloblastic anaemia in hospitalised children. Study design: Prospective study. Setting: Tertiary care hospital in Uttarakhand. Subjects: 53 children between 6 months and 14 years of age were studied for megaloblastic anaemia. Result: Majority of patients (48.8%) were in the older age group, and only 11% were seen in infancy. Folate and vit B12 deficiency was seen in 55% and 88% cases respectively. 44% had combined deficiency of folate and vitamin B12.11% had pure folate and 44% had pure vitamin B12 deficiency. 66% cases with microcytic blood picture, 70%with dimorphic picture, and 90% of pancytopenia patients on marrow examination had a megaloblastic picture. 60% had malnutrition, and majority belonged to the lower socio-economic strata of society.